Pituitary Disorders

Question 1

Are are the clinical presentation of pituitary tumours

Answer 1

Visual loss, headache

Question 2

What is prolactinoma

Answer 2

Where there is a prolactin secreting pituitary tumour

Question 3

How is a prolactinoma treatmented

Answer 3

With dopamine as this decreases the size of the tumour

Radiotherapy or surgery of the pituitary gland affects its other functions

Question 4

How big is a macro-adenoma

Answer 4

Over 1cm

Question 5

What do prolactin inhibit

Answer 5

LH through GnRH

Question 6

What are the symptoms of hyperprolactinaemia

Answer 6

Menstural disturbance
Fertility problems
Galactorrhoea - milky discharge from nipple
Vision loss due to the tumour

Question 7

How does a tumour cause high prolactin below 5,000

Answer 7

It blocks dopamine release and TRH which both inhibit prolactin

Question 8

What is likely to be the cause if prolactin is above 5,000

Answer 8

Active prolactin secretion (prolactinoma)

Question 9

What are the different treatments for prolactinoma sand pituitary tumours

Answer 9

Prolactinomas need dopamine whereas pituitary tumours require surgery

Question 10

what type of vision loss is accompanied by a pituitary tumour compressing the optic chiasm

Answer 10

bitemporal hemi-anopia

Question 11

what symptoms are associated with a pituitary tumour growing sideways

Answer 11

pain and double vision as it compresses eye movement and pain nerves

Question 12

if there is a tumour blocking movement of hormones from hypothalamus to anterior pituitary gland what will happen to the hormones produced by the anterior pituitary

Answer 12

they will decrease except prolactin which will increase as theres no negative control (hypopituitarism)

Question 13

what does growth hormone deficiency result in

Answer 13

children = short statue 
adult = muscle weakness and tiredness

Question 14

what is the result of a gonadotropin deficiency

Answer 14

children = delayed puberty 
adult = loss of secondary sexual characteristics

Question 15

what are symptoms of a TSH deficiency

Answer 15

cold, weight gain, tiredness, slow pulse

Question 16

what are the symptoms of an ACTH deficiency

Answer 16

tired, dizzy, low BP, low sodium

this is life threatening

Question 17

adenomas of the pituitary gland most commonly produce which hormones

Answer 17

prolactin
GH
ACTH

Question 18

which pituitary hormones can a basal blood test screen

Answer 18

TSH, LH, FSH, prolactin

Question 19

which pituitary hormones require a dynamic blood test

Answer 19

cortisol and GH (these change throughout the day)

Question 20

what types of dynamic blood tests can be taken

Answer 20

stimulation test for suspected deficiency and suppression tests for suspected excess

Question 21

what stimulation and deficiency tests are used for ACTH and GH

Answer 21

ACTH
stimulation = response to hypoglycaemia
suppression = steroids

GH
stimulation = hypoglycaemic stress
suppression = glucose

Question 22

how can the pituitary gland be viewed

Answer 22

by MRI

Question 23

what is the treatment for prolactinoma

Answer 23

dopamine agonists to stimulate D2 receptors

Question 24

what is the treatment for a non-functioning pituitary adenoma

Answer 24

surgery or radiotherapy

Question 25

what drugs can cause high prolactin levels

Answer 25

dopamine antagonists e.g. anti-sickness and anti-psychotic drugs

Question 26

what is acromegaly

Answer 26

where there is a GH secreting pituitary tumour

Question 27

what are the long term complications of acromegaly

Answer 27

• premature cardiovascular death
• hypertension
• diabetes
• increased risk of thyroid cancer
• large hands and feet

Question 28

what biochemical tests can confirm acromegaly

Answer 28

oral glucose tolerance test with failure to suppress GH

elevated IGF

Question 29

how is acromegaly treated

Answer 29

• surgical removal of tumor
• dopamine agonists and somatostatins to decrease GH secretion
• radiotherapy

Question 30

what is Cushing’s disease

Answer 30

where there is an ACTH secreting pituitary tumour

Question 31

what is the appearance of Cushing’s disease

Answer 31

• round pink face
• skinny and weak arms and legs
• easily bruised
• red stretch marks on abdomen
• high blood pressure
• diabetes
• osteoporosis

Question 32

what is the difference between Cushing’s disease and Cushing’s syndrome

Answer 32

cushing’s syndrome is high ACTH levels not due to a pituitary tumour

Question 33

what is diabetes insipidus

Answer 33

conditions characterised by excesisve thirst and large quantities of pale urine due to a posterior pituitary gland secreting ADH

Question 34

what is another name for ADH

Answer 34

vasopressin

Question 35

what is the role of vasopressin

Answer 35

bind to a vasopressin receptor in the kidney opening aquaporins so that water is reabsorbed

Question 36

what is the difference between cranial and nephrogenic diabetes insipidus

Answer 36

cranial = vasopressin deficiency
nephrogenic = kidneys giving a lack of response to vasopressin

Question 37

what are the consequences of diabetes insipidus

Answer 37

• severe dehydration
• high sodium levels (hypernatraemia)
• coma
• death

Question 38

what is a pituitary apoplexy

Answer 38

a sudden vascular event in a pituitary tumour, this could be:

• bleeding in the tumour (haemorrhage)
• blood supply cut off (infarction)

Question 39

what is the presentation of pituitary apoplexy

Answer 39

sudden onset headache
double vision
vision loss
hypopituitarism

Question 40

in hypopituitarism which hormone deficiency is the most dangerous

Answer 40

ACTH/cortisol